Indiana § 27-8-13-9 - Medicare supplement policies; standards; preexisting medical conditions

§ 27-8-13-9. Medicare supplement policies; standards; preexisting medical conditions

Sec. 9. (a) A Medicare supplement policy, contract, or certificate in force in Indiana may not contain benefits that duplicate benefits provided by Medicare. However, a change in Medicare coverage that becomes effective after a Medicare supplement policy, contract, or certificate is in force in Indiana and that causes a duplication of benefits does not void the policy, contract, or certificate.

(b) The commissioner shall adopt rules under IC 4-22-2 to establish specific standards for policy provisions of Medicare supplement policies and certificates. Such standards shall be in addition to and in accordance with Indiana law. No requirement of IC 27 relating to minimum required policy benefits other than the minimum standards contained in this chapter apply to Medicare supplement policies and certificates. The standards may cover, but are not limited to:

(1) terms of renewability;

(2) initial and subsequent conditions of eligibility;

(3) nonduplication of coverage;

(4) probationary periods;

(5) benefit limitations, exceptions, and reductions;

(6) elimination periods;

(7) requirements for replacement;

(8) recurrent conditions; and

(9) definitions of terms.

(c) The commissioner may adopt rules under IC 4-22-2 that specify prohibited policy provisions not specifically authorized by statute that, in the opinion of the commissioner, are unjust, unfair, or unfairly discriminatory to a person insured or proposed to be insured under a Medicare supplement policy or certificate.

(d) Notwithstanding any other law, a Medicare supplement policy or certificate shall not exclude or limit benefits for a loss incurred more than six (6) months after the effective date of the policy because the loss involves a preexisting condition. The policy or certificate shall not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within six (6) months before the effective date of coverage.

(e) After June 30, 2020, an issuer that makes a Medicare supplement policy or certificate available to a person who is at least sixty-five (65) years of age and eligible for Medicare benefits as described in 42 U.S.C. 1395c(1) shall make at least one (1) Medicare supplement policy or certificate that meets the requirements of section 9.5 of this chapter available to an individual who is eligible for and enrolled in Medicare by reason of disability as described in 42 U.S.C. 426 and 42 U.S.C. 423. This subsection expires January 1, 2025.

As added by P.L.255-1989, SEC.6. Amended by P.L.126-1992, SEC.7; P.L.227-2019, SEC.2; P.L.28-2024, SEC.1.